FINAL Flashcards
1
Q
Gastroesophageal Reflux Disease (GERD) Patho
A
Weak, lower esophageal sphincter tone allows reflux of acid pepsin into esophagus
2
Q
Risk Factors for GERD
A
- Age
- High BMI
- Smoking
- Large meals
- Acidic foods, caffeine, alcohol
3
Q
Causes of Peptic Ulcer Disease (PUD)
A
- H. Pylori bacteria (bacterial infection in stomach)
- Alcohol
- NSAIDs (non-steroidal anti-inflamm drugs)
- Smoking
- Medications
4
Q
Diverticulitis Patho
A
Infected diverticulum pouch = inflammation
5
Q
CMs of Diverticulitis
A
- Cramping & abdominal pain (in LLQ)
- Diarrhea, constipation, distention, flatulence
- Fever, leukocytosis
- N/V
- Diverticular hemorrhage: melena (dark stools from blood), rectal bleeding
6
Q
Diverticulosis vs Diverticulitis
A
-litis = inflammed pouches; infection
-losis = development of abnormal pouches; asymptomatic
7
Q
Ulcerative Colitis
A
- Chronic ulceration
- Affects inner most lining (mucosa) of the large colon & rectum
- Continuous; no skipped lesions
- Stools = bloody & mucous
- Abdominal cramping
- Incrd risk for colon cancer
8
Q
Crohn’s Disease
A
- Chronic, relapsing
- Can affect any part of GI tract from mouth to anus of the entire thickness
- Discontinuous; skipped lesions
- Cobblestone appearance
- Abdominal pain
- Diarrhea w/ or w/out blood
- Anemia from malabsorption
9
Q
Complications of Lower GI Disorders
A
- Fistula: abnormal opening/pathway of 2 surfaces tht aren’t suppose to touch
- Abscess: collection of infection under skin
- Perforation w/ peritonitis: a hole tht develops in wall of organ tht becomes inflammed
- Necrotic bowel
10
Q
Portal Hypertension Patho
A
Localized pressure in portal veins (of liver) is high due to scarring of the liver causing blood to not go back to heart resulting in accumulation of blood = HTN
(high BP in portal venous system; >10mmHg)
11
Q
CM for Portal HTN
A
- Esophageal varices
- Ascites
- Splenomegaly
- Hepatic Encephalopathy
12
Q
Cirrhosis Patho
A
- End stage liver disease
- Functional liver replaced by fibrosis & scarring
- Constrictive bands disrupt flow of blood vessels & biliary ducts
>leads to portal HTN bc blood is not metabolize
>leads to bile stasis from obstruction of biliary channels = death of liver cells & liver failure
13
Q
Causes of Cirrhosis
A
- Alcohol
- Viral hepatitis
- Autoimmune
- Primary & secondary biliary cirrhosis (destructive of bile ducts)
- Nonalcoholic fatty liver disease
14
Q
Causes of Jaundice
A
- Excessive destruction of RBCs
- Impaired uptake of bilirubin by liver cells
- Drcd conjugation of bilirubin
- Obstruction of bile flow
- Excessive extrahepatic production of bilirubin
(basically cirrhosis?)
15
Q
Jaundice Patho
A
Fibrotic liver cells are unable to uptake bilirubin, metabolize bilirubin, and excrete bilirubin in bile
16
Q
Hepatitis Prevention
A
- Hep A: hand-washing (fectal-oral route)
- Hep C: avoid shared needles & blood of someone else infected
(most common reason for liver transplant)
17
Q
Hepatitis CMs + Phases
A
- Prodromal / Pre-icterus
>abrupt to insidious: malaise, myalgia, fatigue, anorexia, N/V, diarrhea, abdominal pain, fever chills; serum lvls of AST & ALT incr - Icterus (jaudice); 7-14 days laters
>jaundice, pruritus, liver tenderness, rise in serum bilirubin - Recovery; complete recovery 1-4 mnths
>jaundice disappears, return to normal
18
Q
Lab Values of Liver Dysfunction
A
- Liver enzymes: high
>aspartate transaminase (AST): highest in hepatitis/cancers
>alanine transaminase (ALT): specific to liver inflamm
>alkaline phosphatase (ALP): liver disease; bile obstruction - Bilirubin: high
- Prothrombin Time (bleeding): prolonged; liver isn’s synthesizing clotting factors & vit K
- Ammonia: high
- Albumin: low
19
Q
Substances of Gallstones
A
- Cholesterol
- Biliary salts
20
Q
Causes of Cholecystitis
A
- Calculous (90%): obstruction by stones = inflammation
- Acalculous (10%): infection/sepsis or trauma; no stones
21
Q
Pancreatitis Patho
A
- Autodigestion (pancreas digesting itself) of tissue by abnormal activation of pancreatic enzymes (trypsin)
- Inflammatory response
- Incrd vascular permeability leads to hemorrhage, edema, & necrosis
>mild to severe symptoms
>may progress to multi-organ failure
22
Q
Why NPO for Pancreatitis
A
Signal to pancreas to produce enzymes is not activated
23
Q
Type I Diabetes
A
- No insulin secretion
- Autoimmune/idiopathic
- Destruction of beta-cells
- Cannot modify risk
- Peak age: 12-14yrs
- DKA if CM not caught in time
- CM: polyuria, polydipsia, polyphagia
24
Q
Type II Diabetes
A
- Some functional insulin
- Defect insulin receptors
- Incrd insulin resistance
- Can modify some risk to prevent or delay onset
- Peak age > 40yrs
- Complications at diagnosis
- CMs: 3 Ps, blurred vision/retinopathy, paresthesia/PVD, fatigue, frequent infections, wounds slow healing, candida (yeast) infections
25
Hypoglycemia
- Blood glucose >50 mg/dL
- Caused by too much medication, too little food, or excess physical exercise: treat before loss of consciousness
- CM:
>cool, clammy skin
>anxiety, hunger, tachycardia, tremors
>fatigue, confusion, headache, dizziness
>seizures, coma, death
26
Complications of Wound Healing
- Dehiscence: wound separates
- Evisceration: total separation of wound layer, protrusion of organs
- Fistula: abnormal passage btwn 2 organs or to outside of body
- Osteomyelitis: infection of bone
27
Normal Wound Healing
- Goals: fill in, seal, & shrink wound
- Primary Intention: minimal tissue loss, wound edges approximated, little epithelization & shrinkage, low risk infection
28
Types of Bowel Obstruction
- Non-mechanical: failure of normal motility (postop & narcotics)
- Mechanical:
>adhesions: scarring/strictures
>hernia: protrusion through abd wall
>intusseption: (telescope) part of intestine slides into adjacent part
>torsion: complete twisting (vovulus)
>cancer
29
CMs of Bowel Obstructions
- N/V
- Constipation or diarrhea
- Abd pain/distention
- Hyper/hypoactive sounds
RED FLAGS:
- abrupt severe pain
- guarding
- tachycardia
- fever
- bloody stool
(could be perforation)
30
Esophageal Varices
- Back pressure causes vessel varices (bleeding)
- CMs: bleeding/hematemesis, rupture possible
31
Ascites
- Incr in amnt of fluid in peritoneal cavity
- Imapired albumin synthesis; fluid loss out vascular space, low BP
- Inability to metabolize aldosterone; salt & water retention
- Fluid imbalance self perpetuating
32
Splenomegaly
- Spleen enlarges due to PHTN shunting blood into splenic vein
- Hypersplenism develops: dcrd lifespan of RBCs, WBCs, & platelets
- CM: anemia, bleeding, infections
33
Hepatic Encephalopathy
- Liver lost its detoxifying capacity; high blood ammonia lvls circulates brain
- CMs: neural disturbances; confusion/disorientation, asterixis - flapping tremor - early, memory loss/personality changes (euphoria, irritability, anxiety), impaired speech, progresses to deep coma
34
Labs for Diabetes
- HbA1c avg of blood glucose levels over 3 months
- Fasting Blood Glucose
35
Neuropathy
- Chronic complication to microvascular vessels secondary to hyperglycemia
- Damage to myelin sheath (sensory)
>loss of sensation, pain/paresthesia, injuries/foot ulcers
>autonomic neuropathy: end organ damage
36
Retinopathy
- Blindness
- Dcrd blood flow to retina = ischemia, body attempts to repair, leads to scarring, then repeats
37
Nephropathy
- Damage to glomerulus, causes scarring = loss of function
- Progressive renal insufficiency/failure
38
Foot Ulcer/Diabetic Ulcer
Low blood profusion and loss of sensation of lower extremities (peripheral neuropathy) can cause injuries and ulcers
39
Natural-Active Immunity
- Human body is reacting to something
- EX: building antibodies after getting cold
- Cold was already existing, but body MADE memory cells to fight off antigen
40
Acute Inflammatory Response
- Injury to vascularized tissue will activate IR
- Goal: limit extent of tissue damage, destroy microorganism, initiate adaptive IR, begin healing
- CM: HELPR
- EX: infection, necrosis, nutrient deprivation, genetic or immune defects, chemical injury, foreign bodies, temperature extremes, ionizing radiation
41
Natural-Passive Immunity
- Not doing anything, passively receiving
- EX: if mother is sick and makes antibodies and passes antibodies to fetus in womb
- Immunity was not made in a lab, baby did nothing to receive antibodies
42
P in HELPR
PAIN
- Mediator will stimulate the nerve ending, causing pain
43
L in HELPR
LOSS OF FUNCTION
Due to swelling, can cause joints or affected area to lose their function
44
R in HELPR
REDNESS
Due to vasodilation from increased RBC blood flow
45
H in HELPR
HEAT
- Caused by vasodilation from histamine release
- Heat happens because of increased blood flow
46
E in HELPR
EDEMA
SWELLING happens bc vascular permeability increases, causing fluids to come out of the vessels and accumulate in the inflamed area
47
Malignant Tumor Cells
- D not look like normal cells
- Do not perform normal cell functions
- Lack capsules, look like a crap trying to filtrate surrounding tissue
- Grow rapidly, forming "new tissue"
- Don't die (no apoptosis) to keep cell count constant
- Cause destruction & metastasize
48
2nd Stage of Wound Healing
- Proliferation and new tissue formation : 3 days - 2 weeks
- Granulation tissue grows (2nd step) into wound surrounding healthy tissue
- Granulation happens bc of angiogenesis (1st step); forms new capillaries
- Re-epithelialization (3rd step); skin reformation across wound bed
49
1st Stage of Wound Healing
Inflammation : 1-3 days
50
3rd Stage of Wound Healing
- Remodeling and Maturation : 3 weeks - >6 months
- Tissue regeneration, wound contraction continue = scar tissue formation
51
Pressure Ulcer
- Pressure + time = tissue death
- Soft tissue compression btwn bony prominence & external surface, pressure exceeds capillary filling pressure
52
Anemia
- A clinical manifestation, not a specific disease
- Labs: dcr Hgb, Hct, & RBC
- Diminished O2
- Fatigue, weakness, activity intolerance, pallor, cool extremities, exertional dyspnea, rapid HR
53
Iron Deficiency Anemia
- Most common
- Deficient iron = dcr Hgb production = impaired O2 delivery
- Common causes: chronic blood loss (GI bleed, heavy period), poor GI absorption of iron, poor diet
54
Blood Loss Anemia
- Acute: rapid hemorrhage (surgery, trauma), loss of intravascular volume (poor delivery of O2), circulatory collapse (hypotension, tachycardia)
- Chronic: slow bleed (GI, menstrual disorders), does not affect blood volume (leads to iron-def anemia bc production can't keep up, depleted iron storage)
55
Megaloblastic Anemia
- Deficiencies of folic acid, B12, and/or intrinsic factor
- Folic acid: required for DNA synthesis of normal RBC
- B12: required to move folic acid into cells
- Intrinsic Factor: secreted by parietal cells of gastric mucosa, required for B12 absorption, lack causes pernicious anemia
56
Pernicious Anemia
- Lack of parietal cells, unable to excrete intrinsic factor, failure to absorb B12
- Cause: atrophic gastritis, autoimmune destruction of gastric mucosa
- CMs: moderate to severe anemia CMs, demyelination spinal cord causes symmetry paresthesias of feet/fingers, loss of vibratory & position sense, confusion, dementia
57
Hemolytic Anemia
- Inherited disorder of abnormal Hgb
- Dcrd O2 cause distortion of RBC shape (sickle cell); early death of RBC (hemolytic), sickled RBCs stick together & occlude small vessels
58
Erythropoiesis, Erythropoietin
- Erythropoiesis is driven by tissue O2 needs
- Dcr in O2 to tissues is detected by kidneys; kidneys produce erythropoietin (hormone); erythropoietin stimulates production of pro-erythroblasts from stem cells in bone marrow
- RBC self destructs as it squeezes through spaces of spleen or phagocytic macrophages ingest & destroy RBCs
- Heme unit is converted to bilirubin in liver; secreted in bile, feces, & urine
- Rate destruction = rate production (normally)
59
Atherosclerosis
- Progressive disease
- Associated w/ dyslipidemia
- Patho:
>injury to endothemlium & tunica intima (inflamm process) by risk factors
>foam cells: LDL chol invades tunica intima layer, macrophages "eat up" LDL & die accumulating & building fatty layers (streaks)
>plaque structure: smooth muscle cells of tunica media form fibrous capsule of collagen & elastin over fatty streaks & lay down Ca deposits, plaque build up is a repetitive process
>artery lumen narrows: ischemia, effects on body depends on structures involved & extent of altered flow, infarction can occur when plaques dislodge
60
Plaques
- Stable: obstruct flow = little O2, less dangerous
- Unstable: plaque rupture & migration through vessel, more dangerous
61
Peripheral Artery Disease (PAD)
- Progressive disease, atherosclerosis narrows arteries in legs & feet; dcrd blood flow
- CMs: claudication pain, thinning skin, pulse poor/absent, skin cool, ulcers (pale, dry, punched out), surrouding skin dry & shiny, dcrd perfusion, dependent rubor
- Comps: rest pain, ulcers, gangrene, amputation
- Tx: stent, bypass graft
62
Acute Peripheral Artery Occlusion
- Complication of an unstable clot, not progressive
- Unstable plaque or clot obstructs artery; lack of blood supply to extremity results in tissue death in hrs
- CMs: sudden onset 7 Ps
- Tx: thrombolytic therapy, embolectomy
63
Chronic Angina
- Coronary artery disease or MI
- Atherosclerosis
- Angina = chest pain
- Intermittent imbalance btwn coronary blood flow & metabolic demands of myocardium
- Chest pain, SOA, relieved by rest & nitro
- Precipitated by: physical exertion, exposure to cold, emotional stress
64
Right Ventricular Failure (HF)
- Causes: L side ventricular dysfunction, cor pulmonale (COPD), pulmonary HTN, valve dysfunction (tri or pulm)
- Reduced blood flow into pulmonary circulation & L side heart, dcrd CO, incrd pressure of RV/RA/systemic venous system
- End Result: congestion of peripheral tissue
- CMs: congestion of periph tissues; periph edem = fluid weight gain, liver congestion = impaired liver function, GI congestion = anorexia/tissue wasting & GI distress
- SWELLING: swelling (legs, liver, GI), weight gain (fluid, rapid), edema (pitting), large neck vein (JVD), lethargy, irregular HR, nocturia, girth (ascites)
65
Aortic Valve Stenosis
- Aortic valve is btwn LV & aorta
- Hardening of valve
- Incomplete opening; incrd resistance to ejection of blood from LV into aorta; maintains EF until valve 1/4 normal size
- Compensatory mech: LV hypertrophy
- Comp: LV HF
- Causes: age-related calcification, congenital malformation
CMs: murmur syncope, LHF
66
Deep Vein Thrombus (DVT)
- DVT: injury to vessels occurs, inflamm response/clotting cascade initiated = thrombus grows in direction of blood flow
- CMS: unilateral swelling, pain/tenderness, warmth, redness
67
Pulmonary Embolism (PE)
- Risk Factors: Virchow's triad (venous stasis, coagulability, endothelial injury)
- Effects depends on extent of blood flow obstruction, size of vessels, secondary effects (infarction)
- Result: embolism w/ infarction or w/out, massive occlusion, multiple occlusions
- CMs: small; intermittent SOA, exercise intolerance. large; sudden onset, severe chest pain, respiratory distress/acute hypoxemia, loss of consciousness, shock (rapid, weak pulse, hypotension, diaphoresis)
- Dx: V/Q scan, CT scan, ABG
68
Chronic Obstructive Pulmonary Disease (COPD)
- Inflamm & destruction of lung parenchyma/central airways causing irreversible expiratory limit
- Smoking is biggest cause
- Combo of chronic bronchitis & emphysema
- CMs: early; cough (excessive mucus_, incrd RR, exercise dyspnea, wheezing. late; constant dyspnea, trapped air, prolonged expiration, barrel chest & use of accessory muscles, cyanosis, clubbing of fingers, pulmonary HTN/ R HF
- Comps: R HF
69
Chronic Bronchitis
- Excessive mucus production, mucus plugging, & fibrosis
- Hypoxia/hypercapnia, shunting, pulm HTN, cor pulmonale
- Shunting = vasoconstriction everywhere in lungs (no good place) = puml HTN
- Inflamm response is consistent bc irritation is consistent
- Mucus production id from vascular perm
- Blue bloater
70
Emphysema
- Abnormal permanent enlargement & destruction of air spaces distal to terminal bronchioles, loss of elasticity
- Collapse during expiration, air trapping, CO2 retention (hypercapnia)
- Pink puffer
71
Pneumonia
- Infection/inflamm causes excess fluid & edema = poor gas exchange
- Classified according to source: community acquired or hospital acquired
- Risk Factors: recent exposure, tobacco/substance use, chronic lung disease, aspiration risk, mechanical ventilation, immune compromise, age, atelectasis
- Dx: elevated WBC, sputum C & S, ABGs, CXR
- CMs: early; malaise, fever, severe shaking/chills, fine crackles. progression; purulent sputum, pleuritic chest pain, resp distress/acute hypoxemia
72
Fractures
- Injury, stress fracture (incomplete crack), pathologic fracture (underlying cause)
- At risk for: bleeding, circulation & neurologic impairment due to pressure, loss of function, infection
- Types: open/compound vs closed, complete vs incomplete, comminuted (2+ pieces), impacted (2 wedged), compression (2 crushed), transverse (across bone perpendicular)
- CMs: pain, swelling, loss of function/mobility, crepitus or grating as bone fragments rub together, deformity (angulation, shortening, rotation)
- Tx: reduction, immobilization, prevention of complication & restoration of function
73
Fractures Healing & Complications
- 24-72hrs: hematoma
- 3-14 days: granulation tissue (soft tissue callus)
- 4-6 wks or a yr: remodeling
- Comps: impaired healing due to age, inadequate circulation, coagulation disorders, DM, poor nutrition
74
Osteomylitis
- Bloodstream (hematogenous), direct penetration, contamination of open wound
- Bones destruction/abscess, exudate infiltrates, periosteum, blood supply to bone cortex destroyed = necrosis
- CMs: symptoms of bacteremia & local site infection; chills, fever, malaise, edema, erythema, drainage, pain
- Tx: longterm antibiotics, surgery debridement
75
Compartment Syndrome
- Dcr in compartment size (constrictive casts, dressings, etc.)
- Incr in compartment volume (bleeding, inflamm)
- Compromises circulation, death to nerve & muscle cells, permanent loss of function, symptoms begin w/in hrs, muscle necrosis in 4-8hrs
- CMs: pain, parathesia, pallor, pulselessness, poikilothermic, paralysis
- Tx: notify HCP
- Goal: reduce pressure
76
CKD Labs
- GFR: dcrd
- BUN: elevated (incrd nitrogen)
- Surem Creatinine: elevated
- Urine Protein: elevated (leads to swelling, microalbuminuria is 1st symp of CKD)
- Anemia: dcrd RBC & Hgb (kidneys don't release erythro)
- Hyperparathyroidism: dcr vit D & Ca, incr P (kidneys don't excrete P, P & Ca have inverse relationship, kidneys not converting vit D to calcitriol bc of impaired absorption of Ca)
77
Acute Kidney Injury
Abrupt decline in kidney function results in inability to maintain F&E balance and excrete nitrogenous waste
78
Prerenal
- Dcrd blood flow w/out ischemia injury
- Hypovolemia: hemorrhage, dehydration, shock
- Hypotension: poor perfusion
79
Intrarenal
- Conditions tht damage renal structures
- Ischemia: glomerulonephritis, pyelonephritis, sepsis, toxins from massive infections, nephrotoxic meds
80
Postrenal
- Urine outflow blocked
- Bilateral ureteral obstruction, bladder obstruction (BPH, tumor), stones
81
Renal Labs
- GFR estimates how much blood passes through the glomeruli each minute; incrd w/ age & men (musc mass)
- Urinalysis
- Creatinine: product of muscle metabolism, reflects GFR, renal damage: urine level dcr, blood lvl incr, alos incrd during trauma/breakdown of muscle tissue
- BUN: urea made in liver during protein breakdown, reflects GFR & urine concentration ability, incrd when GFR is dcrd, incrd in dehydration, dcrd in fluid excess
82
Brain Herniation
- Incrd ICP: blood, brain tissue, CSF
- Interferes w/ perfusion
- Risk Factors: hemorrhage (brain bleed, CVA), brain tumor, hydrocephalus (excess CSF)
- Early CMs: changed/dcrd LOC (restless, irritable, confusion, drowsiness), headahce, pupils small & sluggish
- Late CMs: worsening tissue hypoxia (lethargy, stupor, coma) HTN, bradycardia, abnormal resp patterns, unilateral large & unreactive pupil
- Comps: displacement of brain tissue from area of high pressure to low pressure, pressure placed on brainstem; control lost (CV & resp), lateral pressure compressed CN III
83
Post Concussion Syndrome
- Lasts days to months, can last yrs
- Persistent headahce, dizziness, attention deficits, irritability, insomnia, impaired judgement, anxiety/depression
84
Tonic-Clonic Seizures
- Tonic phase: immediate loss of consciousness, sharp tonic contractions of musc w/ extension of extrems, incontinence of bowel/bladder, cyanosis if airway compromised
- Clonic Phase: rhythmic bilateral contraction & relaxation of extrems
85
Postictal State
- Recovery period
- 5-30 mins
- Unconscousness/deep sleep, headache, confusion, dysphagia, mem loss, HTN
